Cause-Specific Mortality in Gastroesophageal Cancer: A 30-Year Real-World Analysis from the Vienna Gastroesophageal...

Despite therapeutic advances, gastroesophageal cancers remain associated with high mortality. While most deaths are cancer-related, improvements in therapy and supportive care may alter mortality patterns over time. This study aimed to characterize causes of death and associated clinical factors in a large real-world European cohort.

We retrospectively included 2518 patients with histologically confirmed esophageal, gastric, or gastroesophageal junction carcinomas treated at the Medical University of Vienna between 1994 and 2024. Causes of death were obtained from Austria's national death registry and categorized using International Classification of Diseases (ICD) codes. Fine-Gray competing risk models were applied to identify factors associated with cancer- and non-cancer-related deaths.

At data cutoff, 1863 patients (74%) had died. Of these, 85% of deaths were cancer-related, 12% non-cancer-related, 2% unknown, and <1% suicide. Tumor stage was the strongest predictor of cancer-related mortality, with subdistribution hazard ratios (sHR) increasing from 2.34 (95% CI 1.91-2.86) in stage 2 to 7.42 (95% CI 6.15-8.96) in stage 4 disease compared with stage 1 (all p < 0.001). A higher comorbidity burden also independently increased cancer-related mortality. Non-cancer-related death was primarily associated with older age (≥65 years; sHR 2.21, 95% CI 1.12-4.35, p = 0.021) and stomach tumor location (sHR 1.56, 95% CI 1.08-2.23, p = 0.017), while more recent diagnosis (2020-2024) was linked to a lower risk of both cancer- and non-cancer-related mortality (cancer-related: sHR 0.60, 95% CI 0.47-0.76, p < 0.001; non-cancer-related: sHR 0.43, 95% CI 0.25-0.74, p = 0.002), likely reflecting a combination of evolving treatment strategies, improvements in supportive care, and shorter follow-up in the most recent cohort.

Cancer progression remains the predominant cause of death in patients with gastroesophageal cancer, with tumor stage as the key prognostic factor. These high mortality rates emphasize the need for improved antitumoral treatment and timely palliative care approaches.